Biochemical markers of acute myocardial infarction: strategies for improving their clinical usefulness

• Published in: Annals of clinical biochemistry Vol. 35 ( Pt 3); p. 393
• Main Authors: Katz, I A, Irwig, L, Vinen, J D, March, L, Wyndham, L E, Luu, T, Nelson, G I
• Format: Journal Article
• Language: English
• Published: England 01.05.1998
• Subjects: Biomarkers - blood; Creatine Kinase - blood; Electrocardiography; Female; Humans; Isoenzymes; Male; Myocardial Infarction - blood; Myocardial Infarction - physiopathology; Myocardium - metabolism; Myoglobin - blood; Prospective Studies; ROC Curve; Troponin - blood; Troponin T
• ISSN: 0004-5632
• DOI: 10.1177/000456329803500308

We investigated the early diagnostic utility, including incremental value, of the serum cardiac markers creatine kinase (CK), CK-MB (mass and activity measurements), cardiac troponin T, and myoglobin in the diagnosis of acute myocardial infarction (AMI) in patients presenting to a major teaching hospital with chest pain and non-diagnostic electrocardiographs (ECG). The reference diagnosis of acute myocardial infarction was made by a single, independent cardiologist using World Health Organization criteria. CK and CK-MB mass were the only significant predictors of AMI at presentation to the Emergency Department. Logistic regression analysis revealed that CK did not significantly predict (P = 0.23) myocardial infarction once CK-MB mass was in the model. Using test results on follow up, in addition to presentation CK-MB mass, change in CK-MB mass was the only other significant independent predictor of AMI. Likelihood ratios for various levels of the significant markers in the logistic regression are given. In conclusion, CK-MB mass measurement was the only useful serum cardiac marker for the diagnosis of AMI in patients presenting with chest pain with non-diagnostic ECGs.